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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator S 3 <br /> APPLICATION FOR LAND USE PERMITS H <br /> OWNER �p r\� , �\ SN TELEPHONE <br /> C iv TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS qC1. <br /> �oto <br /> LEGAL DESCRIPTION <br /> TYPE OF pERMIT(s). SINGLE FAMILY DWELLING ❑ AILUJI <br /> IUNO DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ I^ <br /> COMMERCIAL BUILDING COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ c ^' <br /> STRUCTURE/ADDITION USE: Z A <br /> (Home/Cabin; Commercial 8 'ness; Bedroom; Deck; etc.) I� <br /> BUILDING CONTRACTOR: <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yx X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> `o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> W a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a <br /> AND INDICATE NORTH (N). <br /> 0 . <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o' I ,` <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WE AREAS,AND (D) LOT DIMENSIONS. Vv Q <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 0 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. H Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE �I o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. — <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. <br /> T ,R70000np� ao ^d <br /> R n o 3 3 3 p d9 tq <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my " <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible or the detail and accuracy of all information contained In <br /> Information I am providing thisapplication <br /> be relied upon by Countythe ding nof Burinett Wing sconsin In determining d I further cwhe[erlare tto issue azperrmit.e that 1 ; 6> n co^ ! D <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am Drevitling In this 9 ` c,in IV <br /> > <br /> application. I a ree to tt county officials charged with administrating county ordinances or other authorized person to have c <br /> access to the above-tie w as at an a unable time for the purpose of Inspection. o <br /> mgooaogN $$ � <br /> 0 <br /> OWNER'S SIGNATURE \\- �' � m .a o <br /> (date) rn >= mnO <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE »H N«««» <br /> Pe�mi � d ck�d <br />